肠系膜脂膜炎多层螺旋CT表现

Multi-slice spiral CT imaging of mesenteric panniculitis

目的探讨肠系膜脂膜炎的多层螺旋CT(multi-slice spiral CT,MSCT)影像特征及MSCT的诊断价值。方法经腹腔镜或组织穿刺活检病理检查证实的肠系膜脂膜炎患者30例,术前均行腹部MSCT扫描,其中12例行平扫+增强扫描,总结其MSCT影像特征,并与组织病理检查结果进行比较,计算MSCT诊断准确率。结果术前MSCT诊断肠系膜脂膜炎30例;30例肠系膜脂膜炎起自肠系膜根部,由肠系膜根部向两侧腹部生长,达小肠肠袢,且与周围腹腔和腹膜后正常脂肪组织界限较清晰;MSCT平扫见30例病灶呈不均匀脂肪密度增高影,12例增强扫描后未见明显强化;25例可见"假肿瘤包膜征";23例病变呈脂肪密度不均匀增高肿块样改变,可见纤维索条影及软组织密度小结节影,病灶血管周边脂肪密度正常,形成"脂肪晕环征";2例呈软组织密度肿块样病变,血管结构均被软组织病变包埋,未见明显"脂肪晕环征";1例周围肠袢回缩聚集,16例周围肠袢有被推移改变。结论肠系膜脂膜炎MSCT特征性表现为假肿瘤包膜征、脂肪晕环征,MSCT诊断肠系膜脂膜炎具有较高的应用价值。

Objective To investigate the multi-slice spiral CT（MSCT）imaging features of mesenteric panniculitis and its diagnostic value.Methods Thirty patients with mesenteric panniculitis confirmed by laparoscopic or histopathologic result underwent abdomen MSCT plain scan,in which 12 underwent CT enhancement scan.The features of MSCT were retrospectively analyzed and compared with the histopathologic results.The diagnostic accuracy of MSCT was calculated.Results Preoperative MSCT was correct in 30 patients.Mesenteric panniculitis was found from the root of mesentery to the intestine loop,and its boundaries with the surrounding abdominal cavity tissue and retroperitoneal normal fat tissue were clear.In 30 patients,CT plain scan showed an increase in non-uniform fat density,which showed no obvious enhancement by CT enhancement scan. Twenty-five patients were found similar tumorous pseudo-capsule sign.Twenty-three patients were found nodule and fiber strip,and fat-ring sign was formed around blood vessel rim.Two patients were found soft tissue density with no fat-ring sign.One patient was found retraction and fasculation of surrounding bowel loops.Sixteen patients were found displacement of surrounding intenstine.Conclusion The images of mesenteric panniculitis on MSCT are featured by pseudotumor capsule and fat-ring signs,and MSCT has a high value to the diagnosis of mesenteric panniculitis.